**5. Suicide prevention via social media usage**

As has been reiterated severally, and with good reason, Social media have changed the world as we have come to know it, and this includes the mental health of the populace. The potential detrimental, stressor and suicidal capacity of social media use has been largely investigated and somewhat accepted. Dissimilarly, however, the potential use of online social media in suicide prevention is only in its infancy as it is only recently started accruing mainstream attention.

Logically, preventing any menace will center majorly on efforts to handicap its perpetrating factors, and in the same vein, involve an in-depth understanding of its underlying mechanism and attempting to impede it at any and several stages in its evolution.

Almost all cases of successful and failed suicidal attempts have a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) psychiatric illness. Mood disorders, principally major depressive disorder and bipolar disorder are associated with about 60% of suicides [26–28].

Consequently, any efforts at using social media to avert suicide must cater for mental health broadly; increasing its awareness, diagnosis and treatment alongside providing a means to access appropriate help.

Nowadays, in the age of the internet, young people can effortlessly access and share content across the globe in the snap of a finger using varying platforms including but not exclusive to collaborative projects (e.g. Wikipedia and social bookmarking), blogs and microblogs (e.g. Twitter), content communities (e.g. YouTube), social networking sites (e.g. Facebook, WhatsApp), virtual game and social worlds [29]. These avenues can and have been used by youth to find out about suicide and varying means of perpetrating it as well as making suicide pacts with other distressed individuals. Alas, fortunately, this provides an opportunity to find and intervene early if someone expresses suicidal intent as well as an avenue for people who have felt suicidal in the past to help persons currently feeling so.

In a small-scale internet survey administered by Robinson et al. they noted that respondents had identified social media as an avenue to provide support and equally receive help as relating to suicide, with the respondents acknowledging increased feelings of well-being by being able to help and support suicidal persons; the latter further accentuating previous reports that social media users found the ability to help therapeutic in and of itself. This beneficial reversibility of roles provided by social media is not applicable in one-on-one therapy. Another immense advantage of social media also highlighted by respondents was the potential to intervene swiftly if and when persons expressed suicidal intent online. Two previous studies cited this as a unique benefit of social media [30, 31]. One of these reports [31] described a successful intervention in a suicide attempt following the posting of a suicide note on Twitter.

A more representative and personal experience is shared by Reidenberg, the Executive director of the United States-based prevention organization Suicide Awareness Voices of Education (SAVE) [32].

Daniel Reidenberg was scanning Facebook for his suicide-prevention organization on a Friday evening in the spring of 2014 when he noticed the post of a clearly suicidal young widow who had declared the intent to take her life and that of her baby. As he had a wealth of experience working with Facebook and other digital companies on the prevention of suicide, he knew exactly what to do: he contacted Facebook's safety center. Although, there was no indication in the post of the woman's location, he knew Facebook would still be able to find her, and that they did in very few minutes. Facebook employees determined the woman had posted her message from an Internet café in a small village in South America. They contacted the local police. Holding a picture from the woman's Facebook page, police officers walked through the village. Within ten minutes of leaving the café, the police found were able to find her and get her into a hospital and get her childcare [32].

With 2 billion people using social media and 500 million people posting on Facebook alone, there is "a lot of opportunity for intervention and prevention," says Reidenberg. "It's critical that everyone starts looking at this new era with technology being involved in the field of suicide prevention. It isn't just going to a doctor's office any longer—it is that 'plus'."

"In a few short years since some of the big social media companies began meeting periodically at Facebook's California head office in 2011 to brainstorm about what to do, the world's largest social network has rolled out a direct intervention. In 25 of the 50 American states, when a user posts a message on Facebook containing a phrase that its algorithms flag as indicating suicidal thoughts or intentions, a banner

#### *Social Media and Suicide DOI: http://dx.doi.org/10.5772/intechopen.92160*

pops up on the user's page. Friends viewing the post can also click on an icon that reports the message, sending it to the Facebook safety centre to review" [32].

The automatic banner asks whether the user needs help and provides the number of the National Suicide Prevention Lifeline. Facebook then contacts the user and offers to connect him or her to the distress line. The message includes tips and links to support videos aligned with best prevention practices. Facebook may also freeze the user's page until the person in distress has interacted with the support applications. The program is billed to be expanded to the entire country and is even said to piloted in some undisclosed countries [32].

A psychiatrist has said that Facebook's program raises a 'thorny' issue as users can post content they don't intend to act on. Reidenberg acknowledged that companies are wrestling with the privacy issue, but he reminded the audience at the International Association for Suicide Prevention's annual conference in Montréal, Quebec, that once someone posts anything on a social media site—even if it's personal health information—it is no longer private [32].

## **6. Novel approaches to suicide prevention**

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb [33]. The contrast between the robust evidence base for several treatments and the continually increasing suicide rate points toward a vital disconnect between the primary problem and the tools we are using to address it [33].

Rightly so, new frontiers and novel approaches to suicide prevention are emerging by the day. One such compelling proposal was made by Michael et al. [33], who propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide.

HIV death rates peaked in 1965, necessitating the need for national-level intervention strategies. However, one that was noted to have been quite effective was the needle exchange program whose aim was to reduce needle sharing, which at the time was the main means of contracting the disease. It also provided an avenue for counseling and health education on safe sex and intravenous drug use. A similar approach was employed to drastically reduce the incidence and prevalence of lung cancer by aggressive public education, increased taxation of cigarette companies, policies limiting places where smokers could publicly smoke as well as the introduction of cigarette filters. By the same token, vehicular accidents were massively reduced by laws imposing the use of seatbelts, child passenger safety and bans on alcohol consumption whilst driving.

Drawing from these largely successful interventions that quelled major public health concerns, Michael et al. resolved that a similar population-level means restriction approach be undertaken. They postulate that achieving a position of strength as regards suicide prevention will stem from a more adept understanding of the mechanism underpinning various aspects of suicide risk. A recent metaanalysis by Franklin et al has shown no increased predictive value of the past few decades of research examining traditional risk factors of suicide. Besides, research has shown that lots of people who think about taking their own lives, never do and the great majority who do try do not die by suicide. The failure of these traditional methods has led to a new approach in suicidology, "ideation to action framework", which has heralded the various psychological theories of suicide. Foremost and oldest amongst these theories is the interpersonal theory of suicide.

The interpersonal theory of suicide (ITS) [34] posits that individuals are at greatest risk of suicide ideation when they feel a sense of burdensomeness to others, lack a sense of belonging, and feel hopeless that these states will change. Although, the ability to make a suicidal attempt is acquired through exposure to painful and provocative events, such as experiences that heighten individuals' pain tolerance and fearlessness about death. Examples of such painful and provocative events include starvation [35], risky illegal behaviors [36], and combat [37]. Additionally, research has indicated that genetic factors may influence individuals' capability for suicide [38]. Conclusively, both suicidal ideation and suicidal capacity must be present for suicidal behavior to ensue [33]. O'Connor's Integrated Motivational– Volitional Model of Suicidal Behavior (IMV) [39] is another suicidal theory influenced by the ITS. Both the IMV and ITS have been empirically tested and supported [40]. Klonsky and May [41] have proposed and empirically tested the most recent of theory within the ideation to action framework, the Three-Step Theory (3ST).

All three theories posit that suicidal intent and suicidal capacity must be present for suicide to ensue. Although defined somewhat differently across each theory, they posit that for a suicidal or lethal attempt to occur, suicidal capacity must be in play. It is important to note that capacity is not in and of itself pathological, in actual fact it is beneficial and can be adaptive in the right circumstances. For instance, increased comfort with blood would prove beneficial to emergency doctors and nurses, likewise, an increased fearlessness of death would enable soldiers to complete a dangerous mission. However, in conditions where persons with an elevated capacity for suicide also experience danger and an increased suicidal desire, the odds for a fatal suicidal attempt increase substantially. Consequently, this offers a promising opportunity for the development of broader-scale national level preventive interventions that target suicidal capacity, even in individuals who deny suicidal thoughts. The most prominent example of such approaches currently in practice, albeit sporadically, is means safety [33]. Novel as this may seem, it's actually an age long, veritably tested and acknowledged measure as evinced by the significant reduction in suicide rates following reduced packaging and access to drugs known to be lethal in high doses, restriction of access to suicide hotspots (bridge barriers), detoxification of gas, ban on popular insecticides frequently used to execute suicide. This effect was witnessed in 2006 in Israel as the Israeli defense Force prevented soldiers from taking their firearms home over the weekend having noted that firearm suicide was high over weekends. As much as a 40% reduction was noted in suicide rates amongst soldiers aged 18–21 following the intervention. Literature, scientific and historical, is fraught with successful campaigns of means restriction/safety. Decreased access to and safe use/storage of lethal means might represent an opportunity to address an important aspect of the capability for suicide without diminishing the ability of individuals to succeed in their chosen professions and environments [33].

A reasonable concern among individuals first hearing about means safety is the possibility that limiting access to one specific method for suicide will simply result in individuals dying by another method. Importantly, this argument has been largely refuted by available research [33]. In his review of means restriction and means substitution research, Daigle [42] found little evidence in favor of means substitution, Similarly, Sarchiapone et al. [43] also examined the effect of broadscale means safety efforts and found that means substitution was uncommon across a variety of methods.

The overwhelming evidence for means restriction and safety, as a means of suicide prevention, lends credence to the recommendation that it be promulgated into law. Whilst a few countries have passed laws and regulations encouraging means restriction, most are yet to. Social media advocacy can be a veritable tool to

#### *Social Media and Suicide DOI: http://dx.doi.org/10.5772/intechopen.92160*

ensure legislation of means restriction and safety globally, public education on the importance of the subject matter and ultimately shift public perception and cultural views on means safety.

Another budding and promising endeavor for the cause of suicide prevention, presented by recent advancements in science and technology, is 'big data'. Generally, big data is high-volume, high-velocity and high-variety data usually in its raw inedited format and coming from diverse sources. This large data set potentially offers scientists and researchers alike, the access to an unprecedented sample size to experiment and test hypothesis and published data. More so, analytics of text, images, videos, audio and social media information can be used to extract information, patterns, relationships and diversities which can in turn be used to predict suicide risk in varying demographics the world over. Additionally, this may also impel the development of online and app-based interventions to extend even to persons who are unawares of their suicidal capacity. One such app is Therapeutic Evaluative Conditioning, TEC, which aims to alter an individual's association with suicidal behavior. Although, caution has been advised with its use, it exemplifies the burgeoning opportunities the use of big-data will afford the world in preventing suicide.
